| NPI | 1649240011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 5101014320) |
| Additional Taxonomies | 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: MI 5101014320) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2024-07-26 |